전립선증식증(Benign Prostatic Hyperplasia)의 한의 임상 진료 현황 조사를 위한 온라인 설문 조사

백지수,신선미,조충식 대한한방내과학회 2023 大韓韓方內科學會誌 Vol.44 No.4

Objectives: This study investigated Korean medicine doctors’ perspectives on clinical practice patterns in the process of developing Korean medicine clinical practice guidelines for benign prostatic hyperplasia. Methods: A questionnaire was developed for Korean medicine doctors. A total of 323 oriental medicine doctors participated in the survey, which was live for a total of 9 days from September 22, 2022, to September 30, 2022. Results: Regarding awareness of treatments for benign prostatic hyperplasia, 63.8% of respondents showed high awareness of Korean medical treatments. However, items such as diagnostic criteria (17.7%), evaluation methods (17.0%), and Western medical treatments (22.9%) showed low recognition rates. In clinical practice, 76.2% of respondents were found to treat five or fewer patients with benign prostatic hyperplasia per month, and the average treatment period was 1 to 3 months for most at 41.2%. Korean medicine doctors diagnosed benign prostatic hyperplasia based on clinical features. The main interventions used were acupuncture, herbal medicine (prescription medicine), and moxibustion. This study has several limitations because of the low response rate for this survey; therefore, the participants are not representative of all Korean medicine doctors. In addition, because the study was conducted broadly on various topics related to benign prostatic hyperplasia, sufficient quality management was not carried out. Further studies that include a larger sample size and more in-depth studies on benign prostatic hyperplasia are needed. Conclusions: It is necessary to develop appropriate and reasonable Korean medicine clinical practice guidelines for benign prostatic hyperplasia.

해김사(海金沙)가 Rat의 전립선비대에 미치는 영향

이두현,이장식,김용성,Lee, Doo-Hyun,Lee, Jang-Sik,Kim, Young-Seung 대한한방내과학회 2010 大韓韓方內科學會誌 Vol.31 No.3

Objective : In benign prostatic hyperplasia, dihydrotestosterone acts as a potent cellular androgen and promotes prostate growth. Inhibiting enzyme $5{\alpha}$-reductase that is involved in the conversion of testosterone to the active form dihydrotestosterone reduces this excessive prostate growth. The mechanism on benign prostatic hyperplasia is substantiating evidence to support the clinical value in the evaluation of therapeutic efficacy. In this study, we investigated the effects of Lygodium japonicum on cyto-pathological alterations and expression of $5{\alpha}$-reductase in the rat model of benign prostatic hyperplasia induced by castration and testosterone treatment. Methods : Sprague-Dawley rats were treated with testosterone after castration for induction of experimental benign prostatic hyperplasia, which is similar to human benign prostatic hyperplasia in histopathological profiles. Lygodium japonicum as an experimental specimen, and finasteride as a positive control, were administered orally. The prostates were evaluated by histopathological changes and testosterone levels. Also, the prostates were observed by hematological alterations of AST, ALT, ${\gamma}$-GTP, BUN and creatinine. Results : The rats treated with Lygodium japonicum showed a diminished range of luminal cell and duct epithelial cell damage. The stromal elements and connective tissue proliferation of Lygodium japonicum treated group as compared to the control group decreased. Conclusions : These findings suggest that Lygodium japonicum may protect the glandular epithelial cells. We concluded that Lygodium japonicum could be a useful remedy agent for treating the benign prostatic hyperplasia.

양성 전립선 비대증 유발 쥐에 단미 한약재가 미치는 영향에 관한 연구 분석

배인숙,정승현,Bae, In-suk,Jung, Seung-hyun 대한한방내과학회 2018 大韓韓方內科學會誌 Vol.39 No.4

Objectives: This study is to review the effect of Korean medicinal herbs on treatment of benign prostatic hyperplasia induced in rat models, as reported in domestic and foreign journals. Methods: Six electronic databases (EMBASE, PubMed, Oasis, RISS, CENTRAL, and Koreankt) were searched with terms including benign prostatic hyperplasia to identify study reports on treatment of benign prostatic hyperplasia impairment with Korean medicinal herbs. After selecting several studies, the analysis focused on items reflected in the diagnosis of benign prostatic hyperplasia, such as prostate weight, thickness of the prostate epithelium, and prostate specific antigen. Results: Six studies were reviewed. Testosterone propionate was used as a benign prostatic hyperplasia induction material in all the included studies. Cinnamomum verum (CV), Cynanchum wilfordii (CW), Ponciri fructus (PF), Quisqualis indica (QI), Acorus gramineus (AG), and Melandrium firmum (MF) had reduced prostate weight statistically significantly. The QI gave a better response than finasteride in terms of reducing epithelium thickness, and the response was statistically significant. The prostate specific antigen level was lower in the group treated with CV than in the control group. Conclusions: CV, CW, PF, QI, AG, and MF had distinct therapeutic effects. However it is difficult to determine which of these is better by comparing them numerically because the observation items evaluated in a rat model of benign prostatic hyperplasia.

전립선비대증 환자에서 발견되는 전립선결석과 하부요로증상과의 관계

김상훈,정규인,이병희,이배영,조수연,김현우 대한배뇨장애요실금학회 2009 International Neurourology Journal Vol.13 No.1

Purpose: Recently as ultrasonography is increasingly used to evaluate lower urinary tract symptoms (LUTS) in the elderly patients, prostatic calculi are more often revealed; however, the mechanism of formation of prostatic calculi is not clearly known, and their impacts on LUTS are controversial. We investigated whether the type and location of prostatic calculi might influence LUTS in benign prostatic hyperplasia (BPH) patients. Materials and Methods: From July 2003 to January 2008, 1,437 consecutive patients underwent transrectal ultrasonography. Of these patients 383 with clinical BPH were retrospectively studied. According to the type (type A: a discrete small reflection; type B: a large mass of multireflection; type M: mixed) and location (periurethral vs. non-periurethral) of prostatic calculi, the serum prostate-specific antigen (PSA) levels, volume of prostate, maximum urinary flow rate and residual urine volume, and International Prostate Symptom Score (IPSS) were compared. Results: Prostatic calcification was found in 70% (268/383), and type A in 38%, type B in 46% and type M in 16%. There was no significant difference according to the presence or types of prostatic calcification, comparing serum PSA levels, volume of prostate, maximum urinary flow rate and residual urine volume. And there was no significant correlation between the types of prostatic calcificaton and each item of IPSS. Periurethral and non-periurethral prostatic calcification failed to show the significant difference in each items of IPSS. Conclusions: There is no significant difference in LUTS according to presence, types, or locations of prostatic calculi in clinical BPH patients. (J Korean Continence Soc 2009;13:30-36)

전립선비대증 환자에서 Transition Zone Index와 경요도전립선절제술 후 IPSS, 최대요속 개선율과의 상관관계

이창호,전윤수,이남규 大韓泌尿器科學會 1999 Korean Journal of Urology Vol.40 No.10

黃柏이 前立腺肥大症 Rat에 미치는 영향

박정준(Jungjun Park),이장식(Jangsik Lee),김용성(Youngseung Kim) 한국한의학연구원 2010 한국한의학연구원논문집 Vol.16 No.2

Objective : Benign prostatic hyperplasia(BPH) is one of the most common diseased among elderly men. BPH can be treated with alpha-1 adrenergic blocker or 5α-reductase inhibitor(Finasteride) that reduces serum dihydrotestosterone(DHT). Phellodendri Cortex Ex has been broad studied on its chemical components, pharmacological activity, and clinical effects on anti-inflammation, anti-allergy, anti-tumor, immunity, antibacteria and other bioactivities. In this study, we investigated the therapeutic effects and action mechanism of Phellodendri Cortex Ex with a BPH induced by castration and testosterone treatment. Methods : Sprague-Dawley rats were treated with testosterone after castration for induction of experimental benign prostatic hyperplasia, which is similar to human benign prostatic hyperplasia in histopathological profiles. Phellodendri Cortex as an experimental specimen, and Finasteride as a positive control, were administered orally. The prostates were evaluated by histopathological changes, and the expression of 5α-reductase genes. Results : While prostates of control rats revealed severe acinar gland atrophy and stromal proliferation, the rats treated with Phellodendri Cortex Ex showed a diminished range of the tissue damage. In the reverse transcription-polymerase chain reaction(RT-PCR) of 5α-reductase genes, Phellodendri Cortex inhibited the expression of 5α-reductase genes. Conclusions : These findings suggest that Phellodendri Cortex Ex may protect the glandular epithelial cells and also inhibit stromal proliferation in association with the suppression of 5α-reductase. From these results, we suggest that Phellodendri Cortex Ex could be a useful agent for treating the benign prostatic hyperplasia.

Prostatic urethral length as a predictive factor for surgical treatment of benign prostatic hyperplasia: a prospective, multiinstitutional study

Kim, Bum Soo,Ko, Young Hwii,Song, Phil Hyun,Kim, Tae-Hwan,Kim, Ki Ho,Kim, Byung Hoon Asian Pacific Prostate Society 2019 Prostate international Vol.7 No.1

<P><B>Background</B></P><P>We hypothesized that prostatic anatomical factors may affect the progression of benign prostatic hyperplasia (BPH) and analyzed whether prostatic anatomical factors could be predictive of the risk of surgery.</P><P><B>Materials and methods</B></P><P>From February to October 2014, 679 men older than 40 years who had lower urinary tract symptoms and enlarged prostates were enrolled from five medical centers. Patients' medical characteristics, serum prostate-specific antigen levels, transrectal ultrasound (TRUS) results, and uroflowmetry were analyzed. Using TRUS in all patients, the total prostate volume, transitional zone volume, prostatic urethral length, transitional zone urethral length, intravesical prostatic protrusion, and prostatic urethral angle were measured. Logistic regression analysis was used to determine factors associated with the risk of surgery. Receiver operating characteristic curves were used to determine cutoff values for significant variables.</P><P><B>Results</B></P><P>Of 679 patients, 37 (5.4%) underwent BPH-related surgery. Prostatic urethral length and transitional zone urethral length were independently associated with the risk of surgery. Age, serum prostate-specific antigen levels, peak flow rate, postvoid residual urine, and other anatomical factors determined by TRUS were not statistically significant with respect to the risk of surgery. Using receiver operating characteristic curve–based predictions, the best cutoff values for prostatic and transitional zone urethral length were 4.53 cm (sensitivity: 83.3%, specificity: 61.6%) and 3.35 cm (sensitivity: 83.3%, specificity: 77.9%), respectively.</P><P><B>Conclusions</B></P><P>This study showed that patients with BPH with longer prostatic and transitional zone urethral lengths had a higher risk of surgery. Prostatic and transitional zone urethral length may be useful predictive factors for medical treatment failure in patients with BPH.</P>

황금(黃芩)이 전립선비대증(前立腺肥大症) Rat에 미치는 영향

김진성,한양희,김용성,Kim, Jing-Sung,Han, Yang-Hee,Kim, Young-Seong 대한한방내과학회 2009 大韓韓方內科學會誌 Vol.30 No.2

Objective : In benign prostatic hyperplasia, dihydrotestosterone acts as a potent cellular androgen and promotes prostate growth. Inhibiting enzyme 5${\alpha}$-reductase, which is involved in the conversion of testosterone to the active form dihydrotestosterone, reduces excessive prostate growth. Recently Scutellaria baicalensis has been related reports about the effect of baicalein on anti-proliferation of the prostate gland. In this study, we investigated the effects of Scutellaria baicalensis on cytopathological alterations and expression of 5${\alpha}$-reductase in the rat model of benign prostatic hyperplasia induced by castration and testosterone treatment. Methods : Sprague-Dawley rat were treated with testosterone after castration for induction of experimental benign prostatic hyperplasia, which is similar to human benign prostatic hyperplasia in histopathological profiles. Scutellaria baicalensis as an experimental specimen, and finasteride as a positive control, were administered orally. The prostates were evaluated by histopathological changes, testosterone levels, and the expression of 5${\alpha}$-reductase genes. Results : While prostates of control rats revealed severe acinar gland atrophy and stromal proliferation, the rats treated with Scutellaria baicalensis showed a diminished range of tissue damage. In the reverse transcription-polymerase chain reaction(RT-PCR) of 5${\alpha}$-reductase genes. Scutellaria baicalensis inhibited the expression of 5${\alpha}$-reductase genes. Conclusions : These findings suggest that Scutellaria baicalensis may protect glandular epithelial cells and also inhibit stromal proliferation in association with the suppression of 5${\alpha}$-reductase. From theses results, we suggest that Scutellaria baicalensis could be a useful remedy agent for treating benign prostatic hyperplasia.

전립선암과 양성 전립선 비대증을 위한 운동 치료적 전략

윤진환 ( Jin Hwan Yoon ) 한국스포츠정책과학원(구 한국스포츠개발원) 2020 체육과학연구 Vol.31 No.1

[Purpose] Prostate problems, such as prostate cancer, and benign prostate hyperplasia have been recognized as problems largely related to androgens and genetic factors. They affect a large fraction of the elderly population, contributing significantly to morbidity and mortality. Therefore, the purpose of this review paper was to investigate a therapeutic strategies for prostate cancer and benign prostate hyperplasia. [Methods] In order to determine the therapeutic exercise strategies for prostate cancer and benign prostate hyperplasia, previous literature was reviewed with MEDLINE, PubMed, and Scopus databases. [Results] Prostate cancer and its associated treatments can cause significant and lasting morbidities, such as cardiovascular and sexual dysfunctions. Various interventions have attempted to prevent or mitigate these dysfunctions. This review summarizes the available evidence concerning the effects of exercise training on male sexual health in the cancer prevalent population. Smoking cessation, regular exercise, and maintaining healthy weight are important public health targets for intervention. Importantly, several lifestyle modifications may lower the risk of developing more aggressive cancer or offer survival benefits to prostate cancer patients. [Conclusions] In this review article, physical exercise training can increase apoptosis markers in the prostate, suggesting exercise training as a potential novel therapeutic strategies for treating prostate cancer and benign prostate hyperplasia. Future studies in more advanced and varied prostate cancer populations are required to ascertain the duration, intensity and frequency of exercise that optimizes the effects of exercise training on prostate cancer and benign prostate hyperplasia. [목적] 전립선암과 양성 전립선 비대증 같은 전립선 문제는 안드로겐 및 유전적 요인과 주로 관련된 문제로 인식되어 왔는데, 이러한 문제는 노인들에게 많은 영향을 미쳐 이환율과 사망률에 크게 기여한다. 전립선암과 그와 관련된 치료법은 심혈관 및 성기능 장애와 같은 중요하고 지속적인 이환율을 유발할 수 있는데, 이러한 기능 장애를 예방하거나 완화시키기 위해 다양한 중재가 시도되었다, 본 연구의 목적은 전립선암과 양성 전립선 비대증을 위한 운동 치료적 전략을 도출하기 위하여 MEDLINE, PubMed와 Scopus 등재된 자료와 이전의 문헌들을 고찰하였다, [방법] 이 리뷰는 전립선암과 양성 전립선 비대증 환자를 위한 운동의 치료적 전략을 위하여 문헌 고찰하였다. [결과] 전립선암과 양성 전립선 비대증 환자에 있어서 규칙적인 운동과 함께 금연, 적정 체중 유지 등 몇몇 생활습관을 개선하면 공격적인 암의 발병율의 위험을 감소시킬 수 있을 것이다. [결론] 본 연구의 결과는 신체적 운동 훈련은 전립선 암세포 사멸의 마커를 증가시켜 운동이 전립선암 및 양성전립선 비대증 치료를 위한 잠재적인 치료 전략으로 제시 될 수 있을 것이다. 미래의 연구들에서는 다양한 전립선암 및 양성 전립선 비대증 환자에 있어서 적정한 운동 기간, 운동 강도, 운동 빈도를 고려한 연구들이 요구된다.

전립선비대증에서 나타나는 조직학적 염증소견의 의미

김현우,김상훈,김세웅,정규인,민기옥,조수연 대한비뇨의학회 2009 Investigative and Clinical Urology Vol.50 No.2

Purpose: Subclinical prostatitis is a very frequent histologic finding in pathological examinations of prostate surgery specimens. We evaluated the correlation between the symptoms of benign prostatic hyperplasia (BPH) and the grades of inflammation in surgical specimens of patients who had undergone operation for BPH without any evidence of clinical prostatitis. Materials and Methods: Seventy five patients with BPH, who had gone through transurethral resection of the prostate (TURP) at our department from March 2004 to May 2007, were retrospectively studied. Of the 75 patients, 57 patients were pathologically diagnosed as having a BPH with prostatitis and 18 patients had the only BPH (group G0). Chronic inflammation was graded as I (group G1: scattered inflammatory cell infiltrate within the stroma without lymphoid nodules), II (group G2: nonconfluent lymphoid nodules) or III (group G3: large inflammatory areas with confluence of infiltrate). The serum prostate-specific antigen (PSA) level, PSA density (PSAD), International Prostate Symptom Score (IPSS) and maximum urinary flow rate were compared among the grades of inflammation. Results: In the patients had undergone TURP, prostatic inflammation was found in 76% (57/75). The storage symptoms of IPSS and PSAD were significantly correlated to the extent of inflammation in each groups (p<0.05). No significant correlations were observed between PSA, size of prostate, voiding symptoms, quality of life (QoL) of IPSS, and maximum urinary flow rate. Conclusions: The extent of chronic inflammation had considerably more relationship with storage symptoms than voiding symptoms and with the increased PSAD. These findings suggest that the subclinical prostatitis may be one of the factors of storage symptoms of BPH patients and postoperative maintained lower urinary tract symptoms. Purpose: Subclinical prostatitis is a very frequent histologic finding in pathological examinations of prostate surgery specimens. We evaluated the correlation between the symptoms of benign prostatic hyperplasia (BPH) and the grades of inflammation in surgical specimens of patients who had undergone operation for BPH without any evidence of clinical prostatitis. Materials and Methods: Seventy five patients with BPH, who had gone through transurethral resection of the prostate (TURP) at our department from March 2004 to May 2007, were retrospectively studied. Of the 75 patients, 57 patients were pathologically diagnosed as having a BPH with prostatitis and 18 patients had the only BPH (group G0). Chronic inflammation was graded as I (group G1: scattered inflammatory cell infiltrate within the stroma without lymphoid nodules), II (group G2: nonconfluent lymphoid nodules) or III (group G3: large inflammatory areas with confluence of infiltrate). The serum prostate-specific antigen (PSA) level, PSA density (PSAD), International Prostate Symptom Score (IPSS) and maximum urinary flow rate were compared among the grades of inflammation. Results: In the patients had undergone TURP, prostatic inflammation was found in 76% (57/75). The storage symptoms of IPSS and PSAD were significantly correlated to the extent of inflammation in each groups (p<0.05). No significant correlations were observed between PSA, size of prostate, voiding symptoms, quality of life (QoL) of IPSS, and maximum urinary flow rate. Conclusions: The extent of chronic inflammation had considerably more relationship with storage symptoms than voiding symptoms and with the increased PSAD. These findings suggest that the subclinical prostatitis may be one of the factors of storage symptoms of BPH patients and postoperative maintained lower urinary tract symptoms.